Amount and Burden of Brain Tissue Hypoxia to Determine Clinical Efficacy of Secondary Decompressive…

Cohort studyNeurosurgery· Aug 2026

Amount and Burden of Brain Tissue Hypoxia to Determine Clinical Efficacy of Secondary Decompressive Craniectomy After Moderate/Severe Traumatic Brain Injury.

Santiago Lubillo, Patricia Lopez, Dacil Parrilla … Daniel Agustin Godoy

Neurocritical CareCohort studyQ1IF 2.7

Higher ischemic burden strongly predicted worse outcome after decompressive craniectomy for traumatic brain injury

Amount and Burden of Brain Tissue Hypoxia to Determine Clinical Efficacy of Secondary Decompressive Craniectomy After Moderate/Severe Traumatic Brain Injury.

Santiago Lubillo … Daniel Agustin Godoy

Neurosurgery · Aug 2026 · Q1 in Neurology

Background

Optimal timing and patient selection for secondary decompressive craniectomy (decompressive craniectomy) in traumatic brain injury (traumatic brain injury) with refractory intracranial hypertension remain uncertain.

Purpose

We aimed to determine whether hypoxic burden and composite ischemic metrics integrating intracranial pressure and PbtO2 are associated with 6-month neurological outcome in patients with traumatic brain injury undergoing secondary decompressive craniectomy.

Methods

This retrospective study included 45 adults with isolated moderate-to-severe traumatic brain injury who underwent decompressive craniectomy for refractory intracranial hypertension (intracranial pressure >25 mm Hg for >60 minutes despite second-tier therapy) at 2 neurocritical care units.

n = 45 adults

Results

odds ratio 0.15 per 1-SD

each 1-SD rise in ischemic burden cut odds of favorable outcome sharply

n = 45 adults

More results

Thirty patients (67%) achieved a favorable outcome.

Favorable outcome was associated with higher admission PbtO2, shorter hypoxia duration (7.5 vs 15 hours, P = .017), and lower hypoxic burden (12.8% vs 70%, P < .001).

Ischemic burden demonstrated good discrimination (area under the curve 0.831).

“

Conclusion

Severity and duration of cerebral hypoxia, particularly when integrated with intracranial pressure into an ischemic burden metric, are strongly associated with outcome after decompressive craniectomy and may improve patient selection and timing for secondary decompression.

Amount and Burden of Brain Tissue Hypoxia to Determine Clinical Efficacy of Secondary Decompressive Craniectomy After Moderate/Severe Traumatic Brain Injury.

Amount and Burden of Brain Tissue Hypoxia to Determine Clinical Efficacy of Secondary Decompressive Craniectomy After Moderate/Severe Traumatic Brain Injury.

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